The Centers for Medicare & Medicaid Services (CMS) has released numerous guidance documents and tools designed to help states prepare for the eventual end of the COVID-19 public health emergency (PHE), including a State Health Official Letter, Promoting Continuity of Coverage and Distributing Eligibility and Enrollment Workload in Medicaid, the Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) Upon Conclusion of the COVID-19 Public Health Emergency (SHO #22-001, dated March 3, 2022).
HHS Renews COVID-19 Public Health Emergency For 90 Days
As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, Secretary of Health and Human Services, Xavier Becerra, renewed the COVID-19 public health emergency (PHE), effective October 13, 2022, for another 90 days.
340B Hospital Reimbursement Rate To Increase After Court Ruling
On September 28, 2022, the United States District Court for the District of Columbia vacated the differential payment rates for 340B-acquired drugs in the Calendar Year 2022 Outpatient Prospective Payment System (OPPS) final rule with respect to their prospective application. The Court ruled:
New Grouper Edits For Home Health Claims
The Home Health (HH) Grouper program has various data validity edits that make sure it uses consistent and accurate data when calculating payment groups on HH claims. Of these edits, currently only a principal diagnosis not assigned to a clinical group causes HH claims to be returned to the provider. Other principal diagnosis code errors aren’t returned to the provider. In some cases, this causes processing problems.
CY 2023 Medicare Deductible, Coinsurance & Premium Rates Update
Patients using covered Part A and Part B services may be subject to deductible and coinsurance requirements. Medicare subtracts an inpatient hospital deductible amount from the amount payable to the hospital for inpatient hospital services it provides in a spell of illness. When a patient gets such services for more than 60 days during a spell of illness, they’re responsible for a coinsurance amount equal to one-fourth of the inpatient hospital deductible for each day of days 61-90 spent in the hospital. A patient has 60 lifetime reserve days of coverage, which they may use after day 90 in a spell of illness. The coinsurance amount for these days is equal to one-half of the inpatient hospital deductible.
